Bone Mineral Density in Type 2 Diabetes Patients with Charcot Arthropathy

Author(s): Hussein A. El Oraby , Mona M. Abdelsalam , Yara M. Eid* , Rana El Hilaly , Heba A. Marzouk .

Journal Name: Current Diabetes Reviews

Volume 15 , Issue 5 , 2019

Become EABM
Become Reviewer

Abstract:

Introduction: Charcot arthropathy is one of the disabling diabetes complications. There are enigmatic areas concerning its underlying pathophysiology and risk predictors. Osteoporosis and local osteopenia have been postulated to have a role in Charcot arthropathy development, but it is still controversial.

Background: The study aims to compare bone mineral density among type 2 diabetics with and without Charcot arthropathy.

Methods: Two groups with type 2 diabetes participated in this study; Group I [30] patients with Charcot arthropathy while Group II [30] patients without charcot arthropathy. All patients underwent full clinical examination and complete history taking with special emphasis on foot problems. Laboratory investigations were done that included fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, serum calcium, serum phosphorus, and alkaline phosphatase. All patients underwent MRI for both feet and dual energy X-ray absorptiometry scan of the lumbar spine and femur. The demographic data, clinical data, the presence or absence of comorbidities and bone mineral density were compared for both groups.

Result: Bone mineral density was significantly lower in Group I than Group II with median lumber T score (-0.15, 1.99 p <0.001), median Femur T score (0.050, 2.400, p <0.001). Group I showed higher propensity for hypertension, neuropathy, micro-albuminuria with peripheral arterial disease (23.33 %) compared to Group II (p <0.001). Multiple logistic regression analysis revealed that female gender and low femur bone mineral density can be risk predictors of the condition.

Conclusion: Bone mineral density is lower in patients with Charcot arthropathy with female gender and Femur T score as risk predictors. Peripheral arterial disease shows greater incidence in Charcot patients than was previously reported.

Keywords: Charcot arthropathy, osteoporsis, type 2 diabetes, diabetic foot, mineral, density.

[1]
Giurini J. A closer look at fixation options for the Charcot foot. Pod Today 2005; 18(11): 16-21.http://www.podiatrytoday.com/article/4728
[2]
Frykberg RG, Mendeszoon E. Management of the diabetic charcot foot. Diabetes Metab Res Rev 2000; 16(1): S59-65.
[3]
Jeffcoate W, Lima J, Nobrega L. The Charcot foot. Diabet Med 2000; 17: 253-8.
[http://dx.doi.org/10.1046/j.1464-5491.2000.00233.x]
[4]
Frykberg RG. Charcot changes in the diabetic foot. In: The Diabetic Foot:.Medical and Surgical Management,. edited by Veves A, Giurini J, and LoGerfo FW,. Humana Press Inc., Totowa, NJ, 2002; pp. 221-46.
[5]
Trepman E, Nihal A, Pinzur MS. Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int 2005; 26(1): 46-63.
[6]
Herbst SA, Jones KB, Saltzman CL. Pattern of diabetic neuropathic arthropathy associated with the peripheral bone mineral density. J Bone Joint Surg 2004; 86-B: 378-83.Published 1 April 2004..
[http://dx.doi.org/10.1302/0301-620X.86B3.14593]
[7]
Jirkovska A, Kasalicky P, Boucek P, Hosova J, Skibova J. Calcaneal ultrasonometry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnover. Diabet Med 2001; 18(6): 495-500.
[http://dx.doi.org/10.1046/j.1464-5491.2001.00511.x]
[8]
Jeffcoate WJ, Game F, Cavanagh PR. The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 2005; 366: 2058-61.
[9]
La Fontaine J, Lavery L, Jude E. Current concepts of Charcot foot in diabetic patients. Foot (Edinb) [Internet] 2016; 26: 7-14.Available from: . http://www.sciencedirect.com/science/article/pii/ S095825921500098X
[10]
Rogers LC, Frykberg RG, Armstrong DG, et al. The charcot foot in diabetes. Diabetes Care 2011; 34(9): 2123-9.
[11]
Jung RH, Greenhagen RM, Wukich DW, et al. Charcot neuroarthropathy and bone mineral density. LER Magazine
[12]
Christensen TM, Bulow J, Simonsen L, et al. Bone mineral density in diabetes mellitus patients with and without a Charcot foot. Clin Physiol Funct Imaging 2010; 30: 130-4.
[13]
Leung HB, Ho YC, Wong WC. Charcot foot in a Hong Kong Chinese diabetic population. Hong Kong Med J 2009; 15(3): 191-5.
[14]
Winkler AS, Ejskjaer N, Edmonds M, et al. Dissociated sensory loss in diabetic autonomic neuropathy. Diabet Med 2000; 17(6): 457-62.
[15]
Stevens MJ, Edmonds ME, Foster AV, Watkins PJ. Selective neuropathy and preserved vascular responses in the diabetic Charcot foot. Diabetologia 1992; 35(2): 148-54.
[16]
Eller-Vainicher C, Zhukouskaya VV, Tolkachev YV, et al. Low bone mineral density and its predictors in type 1 diabetic patients evaluated by the classic statistics and artificial neural network analysis. Diabetes Care 2011; 34(10): 2186-91.
[17]
Sämann A, Pofahl S, Lehmann T. Diabetic nephropathy but not HbA1c is predictive for frequent complications of Charcot feet - long-term follow-up of 164 consecutive patients with 195 acute Charcot feet. Exp Clin Endocrinol Diabetes 120(6): 335-9.
[18]
Tuttolomondo A, Maida C, Pinto A. Diabetic foot syndrome as a possible cardiovascular marker in diabetic patients. J Diab Res 2015; p. 268390.
[http://dx.doi.org/10.1155/2015/268390]
[19]
Zoungas S, Woodward M, Li Q, et al. ADVANCE Collaborative group. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascular complications and death in type 2 diabetes. Diabetologia 2014; 57(12): 2465-74.
[http://dx.doi.org/10.1007/s00125-014-3369-7]
[20]
aKorzon-Burakowska A, Jakóbkiewicz-Banecka J, Fiedosiuk A, et al. Osteoprotegerin gene polymorphism in diabetic Charcot neuroarthropathy. Diabet Med 2012; 29(6): 771-5.; bRajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia 2002; 45: 1085-96.
[21]
Rajbhandari SM, Jenkins RC, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia 2002; 45: 1085-96.
[22]
Bem R, Jirkovska A. Charcot arthropathy and peripheral arterial disease.Diabetes Centre. 2012.Institute for Clinical and Experimental Medicine, Prague..
[23]
Wukich DK, Raspovic KM, Suder NC. Prevalence of peripheral arterial disease in patients with diabetic charcot neuroarthropathy. J Foot Ankle Surg 2017; 55(4): 727-31.
[24]
Gouveri E, Papanas N. Charcot osteoarthropathy in diabetes: A brief review with an emphasis on clinical practice. World J Diabetes 2011; 2(5): 59-65.
[25]
Sohn MW, Lee TA, Stuck RM, Frykberg RG, Budiman-Mak E. Mortality risk of Charcot arthropathy compared with that of diabetic foot ulcer and diabetes alone. Diabetes Care 2009; 32(5): 816-21.
[26]
Kaynak G, Birsel O, Güven MF, Öğüt T. An overview of the Charcot foot pathophysiology. Diabet Foot Ankle 2013; 4
[http://dx.doi.org/10.3402/dfa.v4i0.21117]
[27]
Petrova NL, Shanahan CM. Neuropathy and the vascular-bone axis in diabetes: lessons from Charcot osteoarthropathy. Osteoporos Int 2014; 25(4): 1197-207.
[http://dx.doi.org/10.1007/s00198-013-2511-6]
[28]
Zhao H-M, Diao J-Y, Liang X-J, Zhang F, Hao D-J. Pathogenesis and potential relative risk factors of diabetic neuropathic osteoarthropathy. J Orthop Surg Res 2017; 12: 142.
[http://dx.doi.org/10.1186/s13018-017-0634-8]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 15
ISSUE: 5
Year: 2019
Page: [395 - 401]
Pages: 7
DOI: 10.2174/1573399814666180711115845
Price: $58

Article Metrics

PDF: 26
HTML: 2
EPUB: 1
PRC: 1